Pituitary Disorders Flashcards

1
Q

Are are the clinical presentation of pituitary tumours

A

Visual loss, headache

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2
Q

What is prolactinoma

A

Where there is a prolactin secreting pituitary tumour

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3
Q

How is a prolactinoma treatmented

A

With dopamine as this decreases the size of the tumour

Radiotherapy or surgery of the pituitary gland affects its other functions

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4
Q

How big is a macro-adenoma

A

Over 1cm

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5
Q

What do prolactin inhibit

A

LH through GnRH

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6
Q

What are the symptoms of hyperprolactinaemia

A

Menstural disturbance
Fertility problems
Galactorrhoea - milky discharge from nipple
Vision loss due to the tumour

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7
Q

How does a tumour cause high prolactin below 5,000

A

It blocks dopamine release and TRH which both inhibit prolactin

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8
Q

What is likely to be the cause if prolactin is above 5,000

A

Active prolactin secretion (prolactinoma)

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9
Q

What are the different treatments for prolactinoma sand pituitary tumours

A

Prolactinomas need dopamine whereas pituitary tumours require surgery

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10
Q

what type of vision loss is accompanied by a pituitary tumour compressing the optic chiasm

A

bitemporal hemi-anopia

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11
Q

what symptoms are associated with a pituitary tumour growing sideways

A

pain and double vision as it compresses eye movement and pain nerves

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12
Q

if there is a tumour blocking movement of hormones from hypothalamus to anterior pituitary gland what will happen to the hormones produced by the anterior pituitary

A

they will decrease except prolactin which will increase as theres no negative control (hypopituitarism)

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13
Q

what does growth hormone deficiency result in

A
children = short statue 
adult = muscle weakness and tiredness
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14
Q

what is the result of a gonadotropin deficiency

A
children = delayed puberty 
adult = loss of secondary sexual characteristics
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15
Q

what are symptoms of a TSH deficiency

A

cold, weight gain, tiredness, slow pulse

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16
Q

what are the symptoms of an ACTH deficiency

A

tired, dizzy, low BP, low sodium

this is life threatening

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17
Q

adenomas of the pituitary gland most commonly produce which hormones

A

prolactin
GH
ACTH

18
Q

which pituitary hormones can a basal blood test screen

A

TSH, LH, FSH, prolactin

19
Q

which pituitary hormones require a dynamic blood test

A

cortisol and GH (these change throughout the day)

20
Q

what types of dynamic blood tests can be taken

A

stimulation test for suspected deficiency and suppression tests for suspected excess

21
Q

what stimulation and deficiency tests are used for ACTH and GH

A

ACTH
stimulation = response to hypoglycaemia
suppression = steroids

GH
stimulation = hypoglycaemic stress
suppression = glucose

22
Q

how can the pituitary gland be viewed

A

by MRI

23
Q

what is the treatment for prolactinoma

A

dopamine agonists to stimulate D2 receptors

24
Q

what is the treatment for a non-functioning pituitary adenoma

A

surgery or radiotherapy

25
Q

what drugs can cause high prolactin levels

A

dopamine antagonists e.g. anti-sickness and anti-psychotic drugs

26
Q

what is acromegaly

A

where there is a GH secreting pituitary tumour

27
Q

what are the long term complications of acromegaly

A
  • premature cardiovascular death
  • hypertension
  • diabetes
  • increased risk of thyroid cancer
  • large hands and feet
28
Q

what biochemical tests can confirm acromegaly

A

oral glucose tolerance test with failure to suppress GH

elevated IGF

29
Q

how is acromegaly treated

A
  • surgical removal of tumor
  • dopamine agonists and somatostatins to decrease GH secretion
  • radiotherapy
30
Q

what is Cushing’s disease

A

where there is an ACTH secreting pituitary tumour

31
Q

what is the appearance of Cushing’s disease

A
  • round pink face
  • skinny and weak arms and legs
  • easily bruised
  • red stretch marks on abdomen
  • high blood pressure
  • diabetes
  • osteoporosis
32
Q

what is the difference between Cushing’s disease and Cushing’s syndrome

A

cushing’s syndrome is high ACTH levels not due to a pituitary tumour

33
Q

what is diabetes insipidus

A

conditions characterised by excesisve thirst and large quantities of pale urine due to a posterior pituitary gland secreting ADH

34
Q

what is another name for ADH

A

vasopressin

35
Q

what is the role of vasopressin

A

bind to a vasopressin receptor in the kidney opening aquaporins so that water is reabsorbed

36
Q

what is the difference between cranial and nephrogenic diabetes insipidus

A
cranial = vasopressin deficiency
nephrogenic = kidneys giving a lack of response to vasopressin
37
Q

what are the consequences of diabetes insipidus

A
  • severe dehydration
  • high sodium levels (hypernatraemia)
  • coma
  • death
38
Q

what is a pituitary apoplexy

A

a sudden vascular event in a pituitary tumour, this could be:

  • bleeding in the tumour (haemorrhage)
  • blood supply cut off (infarction)
39
Q

what is the presentation of pituitary apoplexy

A

sudden onset headache
double vision
vision loss
hypopituitarism

40
Q

in hypopituitarism which hormone deficiency is the most dangerous

A

ACTH/cortisol